Physicians should make the final decision on whether a patient receives an expensive treatment with drug-eluting stents or the less-expensive metal variation, according to a new study that examines the economic, social and legal issues raised by this new technology.
That conclusion was a key finding of a six-month study conducted by the Bethesda, Md.-based Society for Cardiovascular Angiography and Interventions, which examined the "critical dilemma" faced by hospitals and physicians in dealing with a popular life-saving device that costs approximately three times as much as bare-metal stents -- or about $3,000 vs. $1,000.
The tiny metal tubes, coated with a drug that helps prevent arterial renarrowing, or restenosis, cost hospitals an average of about $1,400 per patient because of a shortfall in reimbursement by Medicare and other health insurers. And even though the health benefits are undisputed -- they reduce the risk of arterial renarrowing by 60% to 80%, the study said -- the high cost of the stents is likely to place "intense pressure" on the healthcare system, triggering more scrutiny and second-guessing by physicians and hospitals over which patients should receive them.
"We wanted the decision to be left in the hands of physicians," said John Hodgson, M.D., a physician who serves as SCAI president and chaired the 22-member task force. "We addressed these issues so that physicians could make informed decisions in the best interests of their patients."
The 64-page report, available on the SCAI Web site, also identifies the types of patients most likely to benefit from the use of drug-eluting stents and calls for Medicare and other health insurers to re-evaluate reimbursements issues.
It points out that drug-eluting stents deprive hospitals of another vital revenue stream, as approximately 20% of patients who would have had coronary artery bypass surgery -- a procedure that typically results in an average of $1,300 profit per patient -- are now likely to be treated with the new devices. What's more, the study added, one analysis estimated that overall medical costs for each patient treated with a drug-eluting stent would be about $900 higher during the first two years after the procedure than for those individuals who received metal stents.
Drug-eluting stents will not become "cost-effective" for a wider range of patients until the price drops or reimbursement increases, the study noted.
"The ultimate cost-effectiveness may not be determined for some time," the report said.